Schizophrenia

What do you know about schizophrenia? What do you think you know about schizophrenia? What do you want to learn about schizophrenia? We hear the term a lot... but do you really know what this condition is? Before you start reading this unit, write down answers to the three questions above and compare them to someone else's answers.

Most people tend to think that schizophrenia is a spilt personality. This isn’t the case. The split is between the person’s thought processes and reality. Consequently schizophrenia is a type of ‘psychosis’.

Bullet point 1 - Types, Symptoms and Characteristics

﻿Types of schizophrenia﻿

There are five main sub-types of schizophrenic disorder that you need to know: · Disorganised schizophrenia:Disorganised behavior and rambling incoherent speech. Marked flattening or inappropriateness of affect. · Catatonic schizophrenia:Psychomotor abnormality is the central characteristic. Adoption of strange postures and flailing limbs. Often will resist all attempts to move them.· Paranoid schizophrenia:Delusions and or hallucinations are the predominant characteristics. Negative symptoms such as flattening of affect and poverty of speech are less apparent than in other types.· Undifferentiated schizophrenia:This type is diagnosed when the patient shows symptoms of schizophrenia but does not fit into the three other types.

· Residual schizophrenia:Patients who have once suffered from more extreme schizophrenia but who now only have milder symptoms, such as bizarre thoughts, withdrawal and affective flattening.

﻿Psychology moves on! Types and the DSM 5...﻿

﻿In the newest edition of the Diagnostic and Statistical Manual (2013) - the book used to diagnose mental illnesses - the subtypes of schizophrenia have been SCRAPPED!

"The DSM-IV subtypes of schizophrenia (i.e., paranoid, disorganized, catatonic, undifferentiated, and residual types) are eliminated due to their ﻿﻿limited diagnostic stability, low reliability, and poor validity﻿. ﻿These subtypes also have not been shown to exhibit distinctive patterns of treatment response or longitudinal course. ﻿Instead, a dimensional approach to rating severity for the core symptoms of schizophrenia is included in Section III to capture the important heterogeneity in symptom type and severity expressed across individuals with psychotic disorders."﻿

In your own words, write a brief explanation of what this section means.﻿

﻿Although the most modern psychiatric manual has eliminated the sub-types, you still need to know them for your exam! The changes are useful as they provide you with lots of evaluation material to use if you are evaluating the definition or diagnosis of schizophrenia.﻿

Assignment 1 - Section A questions

Answer these from memory:

13 (a) Explain, in your own words, what is meant by ‘type of schizophrenia’. [2] (b) Describe two types of schizophrenia [4]

Characterisitcs of schizophrenia

Although the 'types' of schizophrenia given above (and the symptoms given below) make it clear that there is a wide variety in schizophrenic behaviours and conditions, there are some common features that are characteristic of all schizophrenic diagnoses:

Loss of contact with reality - All schizophrenics have difficulties distinguishing reality from fiction.

Muddled or confused thoughts - As a result of things like hallucinations and delusions

Diagnosing schizophrenia

﻿Two or more symptoms must be present for a significant amount of time in a one month period. One of the two symptoms must bedelusions, hallucinations, or disorganized speech.

A disturbance in lifestyle must last for six months (e.g. poor functioning at work or in interpersonal relationships).

Other disorders (e.g. schizoaffective disorder and depressive or bipolar disorder with psychotic features) have been ruled out﻿

﻿Positive symptoms﻿

﻿Positive symptoms come from the patient's own individual reports. They include:

1. Hallucinations: hearing or seeing something that is not there. The most common type of hallucination is ‘hearing voices’. Hallucinations can occur in all sense modalities.

2. Delusions: a delusion is an idea of belief that is fervently believed without question by the sufferer when in fact the idea has no real basis in reality. Some frequent types are delusions of grandeur and persecutory delusions.

3. Disorganised Speech: As thoughts may be jumping from one topic to another in an unconnected and incoherent way, so will a sufferer’s speech. This is sometimes called a ‘word salad’.

4. Disorganised Behaviour: Unpredictable, sudden or unexpected behaviour, which can make dressing, washing etc difficult. In extreme cases this can include catatonia.﻿

2. Avolition (lack of will): tendency to withdraw from interactions with other people, loss of affection, loss of interest, inability to make decisions.

3. Absence of social functions: poor social skills or abilities to interact with people. This can lead to isolation and social withdrawal.﻿

Note that it is difficult to diagnose schizophrenia from positive symptoms alone. They are subjective and can only be inferred on the basis of the individual’s reports. Negative symptoms can be observed and therefore easier to diagnose. ﻿

Assignment 2 - Diagnosis mnemonic

Think of a mnemonic using HDSBDAA (the first letters of the positive and negative symptoms of schizophrenia)

Assignment 3 - You are the psychiatrist

Watch the video to the right, which features interviews with four schizophrenic patients. How many of the diagnostic criteria that you have just learned can you identify? Would you personally diagnose them with the condition?

What about the patient described in this report? Would you diagnose them?

﻿When and where is schizophrenia diagnosed most commonly?﻿

﻿Age of onset﻿

﻿Urbanicity - schizophrenia in the city﻿

﻿Download the document below, which contains data from a large scale study of schizophrenia by Pedersen&Mortensen(2001). The questions will test your ability to interpret data and to draw conclusions.﻿

Assignment 4 - Schizophrenia information service

Schizophrenia is a very misunderstood condition. It is often confused with dissociative identity disorder, and people also often believe that schizophrenics are all dangerous to other people.

Create an information brochure to inform the public about the true nature of the condition.

Implications for diagnosing schizophrenia... serious concerns

DSM IV has low diagnostic reliability. Different clinicians may arrive at different diagnoses because of the wide range of symptoms. It is hard if not impossible to diagnose type 1 (positive) symptoms due to the fact they are unobservable.

DSM IV has low predictive validity because the causes, treatments and prognosis are not the same for all patients (people don’t all fit into one classification)

Classification may result in labelling. This may lead to people being stigmatised with ensuing difficulties in work, relationships etc.

Someone with schizophrenia may not realise they are ill and might refuse the treatment they need. As a result they may be admitted to hospital against their will under the Mental Health Act. This raises serious ethical issues of consent.

Stop and think!! You've already seen these...

The same issues will be relevant here as with diagnosing almost any other mental illness!

You've already seen these points on the 'Models' page, and they'll be repeated regularly.

Assignment 5 - G2C Online research

Now use the information on the website to prepare a presentation which you will be able to give to the rest of your class.

Assignment 6 - G2C questions

Use the G2C webpage for schizophrenia to answer the following questions. Submit the answers by email or through the homepage.

1. Why do neuroscientists suspect that several neurotransmitters may be involved in producing schizophrenia?2. How are genes and neurotransmitters related to the appearance of schizophrenia?3. Explain why the identical twin of an individual with schizophrenia is more likely to develop the disorder than a fraternal twin or older sibling, but is not guaranteed to develop it.4. Identify regions of the brain thought to be involved in schizophrenia, and provide evidence why scientists think these areas are involved.5. How can the use of animal models contribute to better understanding of schizophrenia?

The genetic explanation for schizophrenia

Genetic studies will look at families and twins. For example, if one person in a pair of twins has a condition, researchers may want to establish the probability
that the other twin will also be schizophrenic – this is called the concordance rate. Complete the worksheet to the right to introduce yourself to these ideas.

The basic logic of the genetic explanation is that if a condition is genetic, then as people become more closely related to each other (so sharing more genes) they should also be more likely to share the same psychological conditions.

Evidence for the genetic explanation

Gottesman & Shields (1972) performed a twin study where they examined the records of 57 schizophrenics between 1948 and 1964.

About 40% of the twins were determined to be MZ (monozygotic i.e. identical) and about 60% DZ (dizygotic/non-identical). If the pair were discordant, where one had schizophrenia and the other did not, then the non-schizophrenic was followed for at least 13 years to see if it developed later.Concordance rates, (i.e. probability of a twin having schizophrenia if its twin has the disorder) were as follows:· Monozygotic twins 42%· Dizygotic twins 9%

What does this evidence show? Write a conclusion based on the figures above.

Click to enlarge

In another study, Gottesman (1991) summarised about
40 studies in a meta-analysis. The results are shown above.

Do these results show the same or different pattern to those of Gottesman & Shields (1972)? Explain your answer.

﻿The direction of causality - a major issue in mental illness research﻿

﻿As you can see from the evaluation issues above, it is sometimes hard to tell what causes what in psychological illness. We are left with a 'chicken and egg' scenario, where we know that things have changed, but do not know exactly what has caused the change.

This is a major problem for lots of research. For example, if we find that a person with a condition has unusual neurotransmitter levels (see below), we don't know if the condition caused the neurotransmitter levels or if the neurotransmitter levels caused the condition! It is therefore an evaluation issue that you can use repeatedly in your essays, providing you understand it and link it clearly to the topic you have been asked about!﻿

﻿This picture is also very relevant to the nature/nurture debate! See below.﻿

Evaluating the genetic explanation

﻿There is strong evidence for a genetic basis to schizophrenia﻿﻿from the studies of twins.﻿﻿However, concordance rates are not 100% and therefore this data does not exclude environmental input.﻿

﻿The high concordance rates in MZ twins may be explained by the fact that they tend to be treated more similarly than DZ twins and this greater environmental similarity, rather than genetic similarity, may be responsible for the higher level of concordance than in DZ twins.﻿

﻿However, it could be argued that MZ twins elicit more similar treatment from their parents than do DZ twins. This suggests that the greater genetic similarity of identical twins may be a cause, rather than an effect of their more similar parental treatment. Again – what is the direction of the relationship?

These studies show that the cause of schizophrenia is not wholly genetic. Inheritance may put people at risk but stressful life events may trigger the actual onset of the illness.

It has not been identified whether a single gene or several genes are implicated or how they influence the emergence of symptoms.

﻿Genetic explanations are reductionist, as they reduce complex conditions to the supposed activity of just a small number of genes. This seems too simplistic.

Genetic explanations are also deterministic. They seem to offer the sufferer no hope of controlling the condition themselves, as we cannot consciously control the activity of our genes.﻿

We don't know what causes what in schizophrenia... The red arrows are possible causes, but we don't know which one is the most important in forming the condition.

﻿Untangling causality - Adoption studies﻿

﻿The notion that genetic factors are important in producing schizophrenia is supported by adoption studies. One approach is to look at adoptees with schizophrenia compared with their biological and adoptive parents. See the video above for more.﻿

﻿Study - Tienari et al (1991)﻿

﻿AIM – To examine the rate of schizophrenia in adopted children whose biological mothers were schizophrenic.

METHOD – Examined rates of diagnosis in the adopted children (the adopted families did not have any schizophrenia in the family).

RESULTS - A mother with schizophrenia increased the chance of it in the adoptees, but only if the adoptive family were psychologically disturbed themselves in some way.

CONCLUSIONS – There d﻿oes appear to be a genetic basis to schizophrenia.

﻿BUT…Even vulnerable individuals can be protected from schizophrenia if their upbringing is healthy.This shows the importance of an interactionist approach to the condition, such as the diathesis-stress model. Complete the document below to improve your understanding of this interaction.﻿

﻿Dopamine is a neurotransmitter which is active in a number of different important circuits in the brain. The
Dopamine Hypothesis is the name of the theory which suggests that an excess of dopamine is implicated in schizophrenia. Evidence to support the dopamine hypothesis comes from the following sources:

Iverson (1979) found post mortems on schizophrenic patients showed high levels of dopamine in the brain (though these could have occurred after death).

Neuroleptic drugs that block dopamine at the synapse typically reduce many of the symptoms of schizophrenia (Davidson & Neale 1996). However, they affect positive symptoms such as delusions and hallucinations more than negative symptoms such as apathy and immobility. See the treatments section for more...

Findings from patients suffering from Parkinson’s, who have low levels of dopamine. Drug treatment (L-Dopa) to increase dopamine levels can have side effects similar to the s﻿ymptoms of schizophrenia.

Dopaminergic drugs (such as cocaine and amphetamines) can exaggerate the symptoms of schizophrenia in sufferers.

﻿Evaluating the dopamine hypothesis﻿

As is mentioned above, the explanation is supported by the success of treatments which block dopamine receptors. If these drugs reduce symptoms, it suggests that dopamine is an important factor in the symptoms.

﻿It is also supported by the schizophrenic-like symptoms which can occur in Parkinson's disease sufferers who are treated with dopaminergic drugs.﻿

﻿Neuroleptic drugs block dopamine fairly rapidly, but generally fail to reduce with symptoms of schizophrenia for days or weeks thereafter. This is puzzling if high levels of dopamine are responsible for maintaining the symptoms.

The evidence linking schizophrenia and dopamine is mostly correlational. As a result, we don’t know which causes which (the direction of the relationship). N.B. This is the same 'direction of causality' problem as we had above with genetics.

It is a reductionist and over-simplistic explanation as new anti-schizophrenic drugs such as Clozapine work by affecting others neurotransmitters for example, serotonin. See the treatments section for more on this.

The success of treatments which block dopamine receptors doesn't necessarily mean that dopamine caused the condition in the first place. This is the treatment aetiology fallacy! Taking paracetomol relieves a headache but does not mean the headache was cause by a lack paracetomol. This is an issue for ALL DRUG TREATMENTS!

E.g. Tienari (1991) who showed that there does appear to be a genetic basis to schizophrenia, but that even vulnerable individuals can be protected from schizophrenia if their upbringing is healthy.﻿

﻿Key issue - Biological explanations and the nature/nurture debate﻿

﻿As you will know from AS, there is a long standing debate of whether behaviour (or schizophrenia) is due to nature (i.e. inherited, genetic, innate) or whether it is due to nurture (i.e. learning, environment, upbringing etc.).

Schizophrenia is a condition that is often studied in relation to the nature/nurture debate. It has also been used as a question before in the exam. As with most questions in this exam, the important thing is NOT knowing more information, but using the information you already know effectively to answer the specific question. For example, we can use evidence that supports biological explanations as evidence in support of the 'nature' explanation, and evidence against it to support the 'nurture' position. For example:﻿

﻿Supports nature﻿

There is strong evidence for a genetic basis to schizophrenia from the studies of twins. E.g. Gottesman and Shields (1972) found a 42% concordance in MZ twins and 9% concordance in DZ twins

﻿Supports nurture﻿

﻿﻿Concordance rates are not 100% and therefore this data does not exclude environmental input.

The high concordance rates in MZ twins may be explained by the fact that they tend to be treated more similarly than DZ twins and this greater environmental similarity, rather than genetic similarity, may be responsible for the higher level of concordance than in DZ twins.﻿﻿

﻿Cognitive explanations for sch﻿izophrenia﻿

﻿One influential cognitive model of schizophrenia comes from Chris Frith. Frith’s model (1992) tried to explain what might lead to the positive symptoms of schizophrenia. His idea is that people schizophrenia are cognitively impaired (they do not have a clear enough grasp of their own thought processes), with the result that they are unable to distinguish between actions that are brought about by external forces and those that are generated internally.

He believes that most of the symptoms of schizophrenia can be explained in terms of deficits in three cognitive processes:

· Inability to generate willed action;· Inability to monitor willed action;· Inability to monitor the beliefs and intentions of others.

For example, he proposes that the 'inability to generate willed intentions can lead to inaction/avolition or inappropriate actions (look back at the symptoms of schizophrenia if you can't remember them, to see how this links). This means that a sufferer might not do tasks that they needed to do, or might forget which ones they had done and which ones they hadn't.

In contrast, the inability to monitor the beliefs and intentions of others can lead to delusions of reference, paranoid delusions, certain kinds of incoherence and third-person hallucinations. Your own thoughts and 'inner-voice' could be mis-interpreted as someone speaking to you

According to Frith, faulty operation of this mechanism is due to a functional disconnection between frontal areas of the brain concerned with action and more posterior areas of the brain that control perception. He has produced some evidence for his ideas by detecting changes in cerebral blood flow in the brains of people with schizophrenia when engaged in specific cognitive tasks. This shows a nice overlap between cognitive and biological explanations.

Cognitive psychologists are attempting to find evidence for genetic links by examining whether malfunctioning cognitive processing is a family trait.﻿

﻿Evaluating cognitive explanations of schizophrenia﻿

﻿Frith has been criticised as being reductionist where his theory fails to take into account the role of environmental factors.

Cognitive theories don’t explain the causes, only the symptoms of schizophrenia. ﻿

Cognitive explanations can be easily combined with other models (such as biological models), to provide more complete explanations for conditions.

﻿The
disorder is typically diagnosed in adulthood but as yet there is no scientific
evidence that links childhood difficulties in information processing with later
onset of schizophrenia.﻿

Assignment 7 - Section C question

In the Section C 6 mark questions in the exam you will need to be able to write about half a page describing a theory or model. Check that you can do this for the models of schizophrenia by writing half a page on each of the models in this sectionfrom memory.

﻿Biological treatments for schizophrenia - drugs﻿

﻿Neuroleptic drugs (drugs that reduce psychotic symptoms) are often used in the treatment of schizophrenia.

Chlorpromazine is an example of an anti-psychotic drug

The mode of action is to block dopamine receptors in the brain, which means that the post synaptic receptor sites do not respond to dopamine.

These reduce the positive symptoms of schizophrenia (e.g. delusions, hallucinations)…

… however; they have little effect on the negative symptoms (e.g. lack of motivation and emotion, social withdrawal).

Minor side effects include dry mouth and throat, weight gain and drowsiness.

Major side effects are body stiffness or spasms (similar to Parkinson's disease - which makes sense) and involuntary movements of the mouth and tongue (Tardive dyskinesia).﻿

﻿However... Newer atypical antipsychotic drugs work on a wider range of neurotransmitters, for example, Clozapine. Its mode of action is to blo﻿ck ser﻿otoninas well as dopaminereceptor sites. ﻿J﻿﻿ulien (2005) found that clozapine was an effective treatment of schizophrenia﻿. It has been found to be effective for 50% of people who did not respond to other drugs, perhaps because it affects serotonin. However…

1) It is much more expensive than most other drugs for schizophrenia

2) Side effects - It can produce a potentially fatal blood disease in 1-2% of schizophrenic patients and weekly blood monitoring is required.

Also, because they implicate other neurotransmitt﻿ers, these drugs cast doubt on the dopamine hypothesis as a complete explanation.﻿

﻿Assignment 8 - Ethical implications of biological treatments﻿

﻿Compulsory medication sometimes occurs for schizophrenics, and the reduction of the more severe symptoms of schizophrenia has obvious advantages for the carers and families of schizophrenics. Does this mean that patients could or should be given medication without their consent? Should the human rights of one person take precedence over those of another person or society?Create a table like the one in the picture below, with as many advantages and disadvantages of biological treatments for the individual and for society.﻿

﻿General evaluation of drug treatments for schizophrenia﻿

﻿Neuroleptic drugs that block dopamine at the synapse typically reduce many of the symptoms of schizophrenia. However, they affect positive symptoms such as delusions and hallucinations more than negative symptoms such as apathy and immobility.

Anti-schizophrenic drugs have been referred to as pharmacological strait jackets because they only alleviate or contain symptoms, they don’t provide a complete cure. They treat the symptoms not the cause.

Whilst drugs have enabled care in the community, re-admission rates to hospital are high and many patients relapse in the first year after discharge if the drugs are discontinued. Davis et al. (1993) found that if antipsychotic drugs are stopped abruptly then symptoms recur. Patients also often refuse to comply with treatment because of side effects.

Schizophrenic patients are often reluctant to take neuroleptic drugs because of the side effects. As a result, they are sometimes given injections of long-lasting neuroleptics, thus removing the decision whether or not to take a tablet. This clearly has ethical implications.

They are not a full cure. Around 25% of patients show no improvement with traditional neuroleptics, and a further 30-40% do not show full remission.﻿

﻿Biological treatments for schizophrenia - ECT﻿

﻿The procedure of ECT involves an electric current of between 70 and 130 volts being pas﻿sed through the non-dominant brain hemisphere, and an anaesthetic and muscle relaxants are given be﻿fore the treatment itself. 6 to 9 treatments may be given over a month or so.

Originally used by Cerletti and Bini (1938) to help patients with schizophrenia ﻿but it was eventually deemed an ineffective treatment for schizophrenia. Today ECT is used to treat depression, but very rarely for schizophrenia

from http://aspsychologyblackpoolsixth.weebly.com/treatments-of-abnormality.html

﻿This video should give you a clear idea of what a modern ECT session looks like...﻿

﻿Behavioural treatments for schizophrenia - Token Economies﻿

﻿Token economies are systems based in the ideas of behaviourism, specifically operant conditioning and positive reinforcement (as well as occasionally using negative reinforcement and punishment). Secondary reinforcement is a system whereby desirable behaviour is rewarded with a token or point, which can later be exchanged for a reward once a certain number of tokens have been earned. Token economies have been used to reward socially desirable behaviour of long-term patients in psychiatric institutions. For example, for making their bed they might get a reward or a token, which they can then exchanged for a primary reinforcer such as goods or watching a favourite TV programme.﻿

Evaluating token economies

﻿Paul and Lentz (1977) both found that token economies produced improvements in self-care and pro-social behaviour, even in chronic, institutionalised schizophrenics.﻿

﻿However, whilst token economies work when the schizophrenic person is in the institution, once they are removed from the institution the reward is removed and the improved behaviour ceases.

Behavioural treatments do not remove cognitive symptoms such as hearing voices or delusions.﻿

Paul and Lentz (1977)

AIM: to investigate the effectiveness of operant conditioning by reinforcing appropriate behaviour in schizophrenic patients.METHOD: patients were given tokens each time they behaved appropriately. These could be used to purchase small luxury items. Patients also received individual behavioural treatments tailored to suit their needs.RESULTS: both positive and negative symptoms were reduced, leading to more hospital discharges when compared to a control group. Only 11% of patients needed drug treatment compared to 100% of the control group.CONCLUSION: operant conditioning can be an effective means of improving behaviour in people with chronic schizophrenia.

﻿Cognitive-behavioural treatments for schizophrenia - CBT﻿

The cognitive approach would treat schizophrenia by trying to deal with the clients disturbed thought processes.

The process begins by asking the patient to focus on the nature of the voices they hear, for example thinking about the tone or whether the voice is male or female.

Therapists then try to help the patient to understand that the voices are part of their own thought processes.

They ar﻿e also encouraged to develop strategies against the wishes of the inner voices: for example, choosing to pay attention to the voices only at certain times of the day.

﻿Assignment 9 - Interpreting real research - Sensky (2000)﻿﻿

﻿Read the research paper by Sensky (2000) below. Produce an APFCC summary of the research. Try to find a number of different ways that the results of the study could be interpreted. Submit your summary through form on the homepage. ﻿

﻿When evaluating different models and their treatments, try to understand where theories agree and disagree with each other. A very effective evaluation tool is to be able to contrast different models with each other. For example:

P -One issue with drug therapies for schizophrenia is that the drugs can have side effects.E -For example, chlorpromazine may lead to stiffness and muscles spasms similar to the symptoms of Parkinson's disease.E -Side effects are a serious problem as they may encourage patients to stop taking the drug, with the danger that they might then relapse.Contrast -CBT, in contrast, has no side effects as it is purely a talk-based therapy, therefore it may be a better option for many patients who have had a negative reaction to drugs.﻿

Assignment 8 - Schizophrenia concept map

Use https://bubbl.us/ or another site of your preference to create a concept map of the key ideas in schizophrenia. Include the following terms:

End of sectio﻿n essay writing exercise - Section B

We'll now start looking at the Section B 'evaluate' question.The essay will have two parts, a 'describe' section and an 'evaluate' section.14 a) Describe what psychologists have discovered about schizophrenia. [8] 14 b) Some people believe that schizophrenia is inherited whilst others argue that it is learned. Evaluate what psychologists have discovered about schizophrenia andinclude a discussion of the nature-nurture debate.[12]

First read this document, which covers the skills that we want you to learn when approaching these questions. In summary, you need to try to mention a range of information in question a), so try to mention things from all three bullet points in the specification (so here, something from each of the three approaches). For the question b), try to evaluate using issues and debates (same ones as from AS level). On this page, issues such as reductionism, determinism, ethics, data collection methods, scientific-ness, objectivity and other have been mentioned. Use these in your evaluations! Remember to use a PEE format if you find it helpful.

One final point. Make sure you answer the specific question asked! The 2 b) question will always have a little extra requirement in it, where it will ask you to focus your discussion on one specific area or issue. Here is it ethics. At least a paragraph should consequently be devoted to discussing the ethics of these approaches.

Generic mark schemes are given below. Read them carefully before you start writing and make sure your essays fulfill all the requirements. Please submit your essays through the form on the home page.

End o﻿f se﻿ction essay writing exercise - Section C

Section C in your exam always consists of two questions, one 6 mark recall question and one 8 mark application question. There are always two of these types of question, an﻿d you need to choose one.

15 Dr Euripedes works in a mental health unit caring for patients with schizophrenia. Most of the patients have been given anti-psychotics and electroconvulsive therapy. Dr Euripedes believes that their behaviour can best be improved using a token economy system. (a) Describe how the cognitive approach explains schizophrenia. [6] (b) Use evidence to explain how a token economy system could help Dr Euripedes to improve the behaviour of his patients. [8]

16 There are various competing explanations of schizophrenia, one of which is the biochemical explanation. (a) Describe the biochemical explanation of schizophrenia. [6] (b) Suggest how you would investigate whether the cause of schizophrenia is genetic or biochemical. [8]

The first part is a straightforward recall question. This is the longest question you will get which could focus on just a single theory. You need to write about half a page, so a simple revision check is to make sure that you can write half a page of description about every idea/theory/study that is specifically mentioned in the specification.

The second question allows you to be creative. There is no single right answer. All you have to do is give practical and specific ideas for how you might implement the theory you have described in the first question into the scenario they give you. About a page should be a good length. You need to make sure that you are specifically referring to the theories or ideas mentioned in the question. It takes some getting used to writing this way, but it is an area that, with a little bit of practice, you will be able to do very well on.

Have a go at the questions above. Please submit your essays through the form on the home page.

Extension

Schizophrenia at different levels of explanation

Different levels of explanation... in this picture for depression

It is important to understand that the different approaches to psychology are not necessarily rivals, whose explanations always contradict each other. This is not true. In fact, different approaches may simply be describing the same process, but from a different level of explanation.